INCIDENCE OF CANDIDA ALBICANS AMONGST PREGNANT WOMEN/OWERRI METROPOLIS AND NON-PREGNANT
TABLE OF CONTENTS
Title page
Certification ……………………………………………………………………………i
Dedication ………………………………………………………………………………ii
Acknowledgement………………………….……………………………………..iii
List of Tables………………………………………………………………………….iv
List of Figures…………………………………………………………………………v
Abstract………………………………………………………………………………….vi
Table of contents………………………………………………………………….vii
CHAPTER ONE
- Introduction ………………………………………………………
- Objective of the study
- Literature review
- Pathogenesis
- Host defense mechanisms
- Cell medicated immunity
- Therapy of candidacies
- Chemotherapy and treatment of candidacies
- Lmidazoles
CHAPTER TWO
2.0 Material and method
2.1 Sample used
2.2 Study area
2.3 Population sample
2.4 Methodology
2.5 Sample collection
CHAPTER THREE
3.0 Results
3.1 Data presentation
CHAPTER FOUR
4.0 Discussion
4.1 Conclusion
4.2 Recommendation
4.3 References
4.4 Appendix
LIST OF TABLES
TABLE No. TITLE PAGE
- Pregnant women examined
for Candida albicans at the antenatal clinics of
FMC and GH Owerri.
- Non pregnant women screened for Candida
albicans from FMC and GH Owerri.
- Relationship between age group and incidence of Candida albicans amongst pregnant women at the
Antenatal clinics of FMS and GH Owerri.
- Relationship between age group and incidence of Candida albicans amongst non-pregnant women at clinics of FMC and GH Owerri.
LIST OF FIGURES
FIGURE NO. TITLE PAGES
- Graphical Representation of the Relationship between age group and incidence of Candida albicans amongst pregnant and non-pregnant women (control) at the clinics of FMC and General Hospital Owerri.
ABSTRACT
A study on the incidence of Candida albicans was carried out on pregnant and non-pregnant women at the Federal Medical Centre and general Hospital Owerri. High vaginal swabs were used for the study. A total of 120 women were examined for Candida albicans; of which a total of 80 were pregnant women and the remaining 40 were non-pregnant women (used as control). The microbiological standard of identification of the organism was adopted. Of the 80 pregnant women examined for Candida albicans, 68 were infected, which represents an incidence of 85%. Of the 40 non pregnant women (control) examined, 16 were infected, which represents an incidence rate of 40.0%. Greatest percentage of 58% and 56% were recorded in the age group of 18-28 respectively. The pregnant women had a higher incidence rate of 85.0%. The clinical symptoms noted amongst them were itching, irritation of the vulva and a white, cottage cheese-like vaginal discharge.
CHAPTER ONE
1.0 INTRODUCTION AND LITERATURE REVIEW
1.1 INTRODUCTION
Candida are small, oval yeast measuring 2-4 mm in diameter. It causes a disease condition known as candidiasis. Candidiasis is considered an opportunistic and a sexually transmitted infection. It constitutes great health problems to many women. More so, there has been rampant complaints of pregnant and non-pregnant women who attend clinics at Federal Medical centre and general Hospital Owerri about vagina itching and discharge. Being that this is a common symptom of candidiasis, it has become expedient to establish the incidence of this microorganism amongst the population of these women.
In the history of medicine and scientific exploration, new discoveries are made on a regular basis; in fact, many people devote their lives to the identification and treatment of disease. When these disease are discovered, it is often assumed that they are new. These disease might well have been with us for many year. (Marshall et al: 1983).
Although, the term infection and diseases are sometimes used interchangeably, they differ somewhat in meaning. Infection is the invasion or colonization of the body by pathogenic microorganisms, which disease occurs when an infection results in any change from a state of health.
Disease is an abnormal state in which part or all of the body is not properly adjusted or is not capable of carrying on its normal function.
An infection may exist in the absence of detectable disease. Once a relationship between the normal microbiota can benefit the host by preventing the overgrowth of harmful microorganisms, a phenomenon called antagonism (Tortora et al; 1995).
Microbial antagonism involves competition among microbes, one consequence of this competition is the host against colonization by potentially pathogenic microbes by competing for nutrients, producing substances harmful to the invading microbes, and affecting conditions such as PH and available oxygen. When this balance between the normal microbiota and pathogenic microbas is upset, disease can result. For example, the normal bacterial microbiota of the adult human vagina maintains a local PH of 3.5 to 4.5. the presence of the normal microbiota inhabits overgrowth of the yeast Candida albicans, which cannot grow under these conditions and is normally present in small numbers in the vagina. If antibiotics, excessive douching or deodorants eliminate the bacteria population, the PH of the vagria reverts to nearly neutral and Candida albicans can flourish and become the dominant microorganism there.
Candidasis is a disease caused by yeast-like fungus, Candida albicans; that often grow on mucous membranes of the mouth, intestinal tract, and genitor-urinary tract. Infections are usually a result of opportunistic overgrowth when antibiotics or other factors suppress the competing microbiota. It is responsible for occasional cases in non-gonococcal urethritis in male and for vulvovginal candidiasis which is the most common cause of vaginitis. About 75% of all women experience at least one episode.
The lessons of vulvovaginal candidiasis resemble those of oral thrush but produce more irritation, severe itching, thick yellow cottage, cheese-like discharge, and a yeasty odour. Candida albicans is an opportunistic pathogen. Predisposing conditions include use of oral contraceptives and pregnancy. Which causes an merease in glycogen in the vagina. Diabetes, and treatment with broad-spectrum antibiotics are also associated with the occurrence of candida albicans and vaginitis, (Tortora et al; 1995).
Candida albicans and its close relatives account for nearly 80% of nosocomial fungi infections in general, (Talaro, 2008).
The Federal Medical Centre and general Hospital Owerri have both ante-natal and out-patient units; where they rouser different services to patients. Therefore provide a fetile ground for an investigation such as this.
1.1 OBJECTIVES OF THE STUDY
The objective of this study include:
- Detection of Candida albicans in women attending the clinics
- To know the age group mostly affected
- To know the rate (incidence) of Candida infection in Owerri urban.
Literature review
Candida albicans is opportunistic dimorphic pathogenic yeast which is present on the human mucosal epithelial cell surface, (willey et al, 2008). It causes the majority of opportunistic fungal infection. Candidiasis is the mycosis caused by Candida albicans or other Candida species, (Braga et al, 1996). It adhesion is considered therefore to be an important first step in the pathogenesis of symptomatic or asymptomatic infections of buccal or vaginal mucosa, (Dupont, 1996).
In contrast to the other pathogenic fungi, candida albicans is a member of the normal microbiota within the gastrointestinal tract, respiratory tract, vaginal area and mouth. In healthy individuals they do not produce disease because growth is suppressed by other microbiota and other host resistance mechanisms.
However, if anything upsets the normal microbiota and immuno competency, Candida may multiply rapidly and produce, Candidiasis. In some hospitas they may represent almost 10% of nocosomial bloodstream infections. Because Candida can be transmitted sexually, it is also listed by the centre for disease control, 2004 as a sexually transmitted disease, (Talaro, 2008).
No other mycotic pathogen produces as diverse a spectrum of disease in humans as does Candida, (Talaro, 2008). Most infections involve the skin or mucous when the skin or mucous membranes. This occurs becomes Candida in a strict aerobe and finds such surfaces very suitable for growth. Cutaneous involvement usually occurs when the skin becomes overtly moist or damaged.
Oral Candidiasis, or mouth thrush, is a common disease in newborns. It appears as many small, white flecks that cover the tongue and mouth. At birth newborns do not have a normal flora in the oropharyneal area. If the mother’s vaginal area is heavily colonized with Candida, the upper respiratory tract of the newborn becomes colonized during passage through the birth canal. Thrush occurs because growth of Candida cannot be inhibited by the other microbiota, thrush becomes uncommon, (willey et al, 2008).
Vulvovaginal Candidiasis known more commonly as yeast infection, has widespread occurrence in adult women as a result of complication of diabetes, antibiotic therapy, oral contraceptives, pregnancy or any other factor that can disrupt the normal vaginal flora.
The chief symptoms of vagiond cansididiasis are a yellow to white, cottage cheese-like discharge, inflammation, painful ulcerations, itching, soreness and irritation in the vulva (the vulva refers to the external genital organs of the female). The most severe cases spread from the vagina and vulva to the perineum and thighs.
Candidal balanitis (inflammation of the head of the penis) can develop in the male partners of women with thrush; however, it is very rare, male genital yeast infection is much less common than female genital yeast infection.
Of all the areas of the gastrointestinal tract, Candida most often infects the esophagus and the anus. Esophageal candidiasis, which afflicts 70% of AIDS patents, causes painful, bleeding ulcerations, nausea, and vomiting.
Candidal attack of keratinized structures such as skin, hair and nails, called onychomycosis, is often brought on by predisposing occupational and anatomical factors. People whose occupations require their hands or feet to be constantly immersed in water are at risk of finger and nail invasion. intertriginous Candidiasis occurs in most areas of the body where skin rubs against skin, as beneath the breasts the breasts, in the armpit, and between folds of the groin. Cutaneous candidasis can also complicate burns and produce a scaldlike rash on the skin of neonates whose diapers are not changed frequently and therefore are not kept dry (Talaro, 2008).
Candidal blood infection usually becomes systemic in patients chronically weakened by surgery, bone marrow transplants, advanced cancer, and intravenous drug addiction. The presence of candidaa albicans in the blood is such a serious assault that it causes more human mortality than any other fungal pathogen. Principal targets of systemic infections are the urinary tract, edocardium, and brain. Patients with valvular disease of the heart are vulnerable to Candidal endocarditits, usually caused by other species (Candida tropicalis and Candida parpsilosis). A recent development is the tendency of this fungus to produce biofilms on artificial joints, catheters and heart valves. In most of this cases, the colonization is very drug resistant and may require removal of the device until it can be controlled. Candida has reportedly cause terminal infections in bone marrow transplant patient and in recipient of anticancer therapy, (Talaro, 2008).
A presumptive diagnosis of Candida albicans in a vaginal smear (stained) reveals Gram positive budding yeast cells attached to a pseudohyphae, and true hyphae. In many case of vaginal candidasis, infection is detected during a routine pap smear specimens are cultured on standard fungal media incubated at 300C. Identification is complicated by the numerous species of Candida and other look-alike yeasts. Growth on a selective, differential medium containing trypan blue can easily differentiate Candida species from the yeast Crytococcus. Colonies of Candida albicans appear pale blue on trypan medium, whereas crytococcus are dark blue. Confirmation evidence of Candida albican can also be obtained by the germ tube test, the presence of chlamydopores, and multiplepanle systems that test for biochemical characteristics. A sensitive DNA amplification technique has been developed for identifying this species directly from clinical specimens (Talaro, 2008).
Another characteristics of Candida albicans is the production of curved, elongated germ tubes within three hours when the yeast is transferred from a peptone containing medium to mammalian serum at 370C. growth requirements are simple, on sabouraud’s medium, colonies usually reach 0.5mm in diameter after 18hours and develop into high convex, off white colonies 1.5mm in diameter two days. The behaviour of Candia albicans on other media, its failures to split urea can be used in differentiating it from other yeast (Torulopsis, Cryptococcus) and from other candida species. Candida is tolerant of acid and not sensitive
to any antibacterial drug, it thrives. In its normal sites in the body when broad spectrum antibiotics restrain the growth. It uniformly sensitive to the polyene antibiotics and clotrimazole and usually sensitive to 5-fluorcytosine. (willey et al, 2008).
Microscopically, according to Talaro (2008), Candida albicans has a budding cells of varying size that form both elongated pseudohyphae, and true hyphae. Macroscopically, it forms a white to cream colured past with a yeast odour.
Candia albicans is the commonest cause of candidiasis. The yeast’s commensal relationship with humans enables it when environmental conditions are favourable, to mutiply and replace much of the normal flora, (Braga et al, 1996). Candida can be detected in unstained wet preparation of the skin, urine, vaginal discharge or other exudates from mucosal surfaces (Cheesbrough, 2000).
Candida albicans occur as a normal flora in the oral cavity, genetalia, large intestines and skins of 20% of human (Talaro, 2008). Without candida in the intestine, we would be defenseless against many pathogenic bacteria (women’ health, 2005). The yeast state of the dimorphic candida is a non-invasive, sugar fermenting organism while in its fungal state, it is invasive and can produce rhizoids which are very long root-like structures which cause infections/women’s Health, 2005.
Some doctors have diagnosed wrongly that a patient has neurotic anxiety syndrome when they complain of depression, anxiety, recurring irritability, heart burns, indigestion, lethargy, extreme food and environmental allergies and other infection or situations that have not associated with any disease conditions, (Molero et al, 1998). It has been established that most patients that come up with these complaints are actually infected by Candida albicans, (Molero et al 1998).
Candida species, are more than 100 that exist in nature, only few species are recognized as casing diseases in humans. Medically significant Candida species include the following, Candid glabrata, Candida kruseri, Candida dubliniesis, Candida albicans (Hidalgo, 2005). As Candida proliferates in the intestine, it can change its anatomy and physiology from the intestine, it can change its anatomy and physiology from the yeast-like form to the mycelial form (Dimorphic character). The fungal rhizoids can penetrate mucose or intestinal walls, leaving microscopic holes and thus, allowing toxins, undigested food particles, bacteria and yeast to enter the blood stream which is known as “leak gut syndrome” (Roth, 2005). Penetration of the gastrointestinal mucosa can break down the boundary between the intestinal tract and the rest of the circulation and allow entrance into the blood stream of many antigenic substances. Usually candida albicans can cause bronchial or pulmonary disease only in patients already debilitated or rendered susceptible by other diseases.
The presence of this organism in tropical is sprue only of secondary importance; but the prominence of oral and upper respiratory tract as well as the urinogenital tract colonization especially in females, gave considerable impetus to medical mycology during its infancy, which have developed an appropriate experimental animal models to analze the virulence of particular mutants which may help understand the molecular basis of Candida albicans (Cassone and korting, 1999).
The ubiquity, adaptability and pathogenecity of candida albicans and related species during the era of antibacterial antibiotics keeps these fungi constantly before the medical mycologist as important primary cause of a few forms of candidiasis. Candidiasis, also known as a yeast infection is a common fungal infection that occurs when there is a overgrowth of the Candida fungus (Ryan, 1996).
There is some evidence that HIV may also play a direct role in candidiasis and thus research has linked oral candidiasis (thrush) in HIV-infected people to high viral load, regardless of CD4 counts (Aidsmap, 2004).
Authors with this perspective showed that Candida was a normal inhabitant of the vagina and that pregnancy leads to thrush in women. Pregnant women are more often affected than their non-pregnant counter parts; though large numbers of otherwise healthy women of childbearing age (15-25 years) are more prone to this infection because of their sexual activeness and the likelihood of recurrent pregnancies (fidel et al;1995).
However, oral thrush does not develop in women until the fourth to fifth day of life, and thrush may develop in older children and adults who are suffering from multiple endocrine disturbances, underlying deficiencies in natural defense mechanisms. It may also be seen as a complication of diabetes or of therapy with immuno-suppressive antibiotics, or in cancer. Poor oral hygiene or trauma may also facilitate establishment of Candida albicans.
Another frequent involvement of Candida albicans is in infection of the mucosa of the vagina, called vaginal candidiss or vaginitis. Vaginitis is characterized by excessive discharge with a characteristic clumpy, white cottage-cheese appearance. Approximately three quarters of all women suffer at least one attack of Candida vaginitis or the other, (Botu, 2002). There are a number of predisposing causes of vaginal Candidiosis, they include pregnancy, use of oral contraceptives, diabetes, immune defects-both natural and induced, clothing, personal habits and antibiotics therapy.
Unlike vaginitis, Balanitis or Candida balanoposthitis is not common and usually contracted by man from his female partner. Balanitis manifest with an acute inflammatory reaction which resembles the vulvitis seen in women. However, more commonly, 15% or 20% of male partners develop an acute hypersensitivity reaction (Sobel, 1996).
Cutaneous involvement of Candida albicans may also occur, in case of poorly maintained hygiene, and moist which may provide favorable conditions for establishment and proliferation of Candida albicants with the development of paronychia, onychchomycosis, and diaper rashes. The cell wall of candida aldicans is not only the structure in which many biological functions essential for the fungus cells reside but is also a significant source of Candida antigens (Martinez et al, 1998). Proteins and glycoproteins exposed at the external layers of the cell wall surface are involved in several interaction of fungal cells with host antibiotics; has the potential to influence profoundly the host-parasites interactions by affecting the antibody-mediated functions such as opsonin-enhance phagocytosis and blocking the binding actively of fungal adhesions for ligands (Martinez et al, 1998).
